Dr Tara Camille Wong-chiou, OD | |
577 2nd Ave, New York, NY 10016-6377 | |
(650) 714-6052 | |
Not Available |
Full Name | Dr Tara Camille Wong-chiou |
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Gender | Female |
Speciality | Optometrist |
Location | 577 2nd Ave, New York, New York |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1023417243 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | TUV008163-1 (New York) | Primary |
Provider Name | Optic Shades 2nd Ave Inc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1962145417 PECOS PAC ID: 9133506447 Enrollment ID: O20220506000265 |
Mailing Address | Practice Location Address |
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Dr Tara Camille Wong-chiou, OD 155 E 38th St Apt 15b, New York, NY 10016-2664 Ph: () - | Dr Tara Camille Wong-chiou, OD 577 2nd Ave, New York, NY 10016-6377 Ph: (650) 714-6052 |
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